摘要
目的基于肝母细胞瘤PRETEXT分期系统及其相关影像学高危预后因素,总结肝母细胞瘤影像学表现。方法选择2013年1月至2015年6月在首都儿科研究所附属儿童医院经手术和病理确诊的肝母细胞瘤CT影像学资料82例,其中男性42例,女性40例;年龄1个月~11岁,平均年龄1.65岁。观察肿瘤位置、大小、数量、边界、肿瘤内坏死及钙化等征象;此外,基于PRETEXT分期,探讨与预后相关的高危影像学征象(肿瘤侵袭邻近器官、腹水、肿瘤破裂出血、远处器官转移、淋巴结转移、肝静脉受累、门静脉/下腔静脉受累等)关系。结果 PRETEXT分期Ⅰ期5例,Ⅱ期38例,Ⅲ期33例,Ⅳ期6例。肿瘤的CT表现,39例(47.6%)在右叶,22例(26.8%)在左右叶,18例(22.0%)在左叶,3例(3.6%)在尾叶。肿瘤体积约为2.5 cm×2.5 cm×3.0 cm^9.2 cm×18.6 cm×20.0 cm。71例(86.6%)肿瘤单发,11例(13.4%)肿瘤多发。64例(78.0%)肿瘤与肝脏实质多数分界清楚,18例(22.0%)边界模糊。肿瘤内坏死:72例(87.8%)有大小不等、分布无规律、数量不定的裂隙状或片状低密度区(CT值约15~38 Hu)。49例(59.8%)有点片状、团块状和多种形态混合状的钙化。高危预后因素最常见为远处转移33例(40.2%),以肺转移多见;其次是门静脉主干、三支肝静脉或下腔静脉受累13(15.9%)、PRETEXTⅣ期6例(7.3%)、淋巴结转移5例(6.1%),肿瘤肝外腹部侵袭(0例)及肿瘤破裂出血(0例)相对少见。结论肝母细胞瘤的术前增强CT检查可着重观察与临床分期及高危预后相关征象,有助于临床分期、治疗和预后的判断。
Objective To explore the image performances of hepatoblastoma based on pre-treatment extent of disease（PRE- TEXT） staging system and prognostic factors. Methods From January 2013 to June 2015, a total of 82 pathologically diagnosed hepatoblastoma patients were retrospectively analyzed, which included 42 males and 40 females; aged 1-month to 11- year-old with mean age of 1.65 years old. The location, size, amount, boundary, necrosis and calcification were analyzed. In addition, the relationship between PRETEXT staging and prognostic high-risk imaging（tumor invasion adjacent organ, ascites, tumor rupture and hemorrhage, distant organ metastasis, lymph node metastasis, hepatic vein involvement, portal vein / inferior vena cava involvement） were discussed. Results Based on PRETEXT staging, there were 5 cases in stage Ⅰ , 38 in stage Ⅱ, 33 in stage Ⅲ and 6 in stage IV. CT performances showed 39 cases（47.6 %） in right lobe, 22 cases（26.8 %） in left and right lobe, 18 cases（22.0 %） in left lobe and 3（3.6 %） in caudate lobe. The tumor size was 2.5 cmx 2.5 cm × 3.0 cm - 9.2 cm× 18.6 cm× 20.0 cm. Solitary in 71 cases（86.6 %） and muhiple in 11 cases（13.4 %）. Tumor boundary of clear in 64 cases（78.0 %） and fuzzy in 18 cases（22.0 %）. Necrosis in 72 cases（87.8 %） with irregular size, irregular number of fractures or lamellar low density area（CT value = 15 - 38 Hu）. Calcification in 49 cases（59.8 %） with flaky, agglomerated and mixed various forms. The most common prognostic factors were 33 cases（40.2 %） with distant metastasis, followed by pulmonary trunk, three hepatic veins or inferior vena cava in 13（15.9 %）, PRETEXT Ⅳ in 6 cases（7.3 %） and lymph node metastasis in 5 cases（6.1%）, tumor extrahepatic abdominal invasion（0 case） and tumor rupture of bleeding（0 case） was relatively rare. Conclusion CT findings of hepatoblas- toma based on PRETEXT system could guidance the clinical stage, treatment and prognosis.
作者
白凤森
闫淯淳
郭宏伟
袁新宇
BAI Feng-sen YAN Yu-chun GUO Hong-wei YUAN Xin-yu(Department of Radiology, Capital Institute of Pediatrics, Beijing 100020, China)
出处
《生物医学工程与临床》
CAS
2017年第3期280-284,共5页
Biomedical Engineering and Clinical Medicine
